Monday May 26 2014

Women with fistula ignorant about its cause

By Agatha Ayebazibwe

A new study conducted by researchers at the school of public health indicates that most fistula cases recorded at Mulago hospital are blamed on surgery.

The study whose findings have been published in the International Journal of Tropical Disease and Health show that the number one perceived cause of obstetric fistula were injury by surgeon at 27 per cent.

Other causes recorded were delivery of a big baby at 23 per cent, and prolonged labour , and the other causes at 13 per cent.
However, the researchers were quick to say the study is limited because the findings are based on views of a small number of fistula patients at Mulago hospital.

“The limitation of this study is that it is based on the views of a small number of fistula patients with their relatives and health workers involved in their care and may not be generalised to the entire fistula situation in Uganda,” says Dr Joseph Matovu, a public health expert and Co investigator.

He, however, notes, “it highlights the missed opportunities for fistula prevention at various levels and the limited access to timely interventions as well as the severe consequences which are all key findings in terms of informing interventions.”

According to Joani Kabayambi, the principal Investigator of the study, “Living with Obstetric Fistula: Perceived Causes, Challenges and Coping Strategies among Women Attending the Fistula Clinic at Mulago Hospital,” women think that the reason they got fistula is because they were operated.

“They ignore the underlying cause which is obstructed labour. And because they got complications during delivery and the babies were born by C-section, these women think that the condition arose from the surgery,” she says.

This means that, “we have to do more work to sensitise the public on how the condition comes about. In fact, others think it’s a cultural consequence like curses and that’s why they tend to keep away from seeking services in health facilities.”

Obstetric fistula is a medical condition in which a hole develops either between the rectum and the vagina (rectovaginal fistula), or between the bladder and the vagina (vesicovaginal fistula), as a result of obstructed labour in areas with limited medical care. Without being able to get a C-section or receive other medical support, the lives of both mother and baby are put at risk.

The health ministry estimates that anywhere from 140,000 to 200,000 Ugandan women currently have fistula, with 1,900 new cases occurring each year.